How Gender, Sexual Diversity and Stigma Impact HIV en la Frontera May 29, 2014

1. How Gender, Sexual Diversity and Stigma Impact HIV en la FronteraMay 29, 2014

2. Presenters Lisa Schergen, MA Cardea Services Sarah Kapostasy, MA Independent Consultant Oscar Lopez Valley AIDS Council

3. Learning Objectives At the end of this training, participants will be able to: • Discuss the range of gender in the population • Describe how stigma against gender nonconforming people can increase risky behaviors that can lead to HIV positive status, especially in the border community. • Discuss effective strategies to counsel gender diverse clients to improve health outcomes.

4. Genderbread Person It’s Pronounced Metrosexual Site • http://itspronouncedmetrosexual.com/2012/03/the-genderbread-person-v2-0/ Interactive Person • http://cardeaservices.articulate-online.com/p/3074045950/DocumentViewRouter.ashx?Cust=30740&DocumentID=c1587cbf-f6aa-476a-ad2b-7ebe0123d568&Popped=True&v=1&InitialPage=story.html

5. Genderbread Person

6. Inside the Box SurveyPlease answer the following questions by selecting ONE of the following choices. I find that most of the colleagues I work with are... Rational Emotional The room I’m in today for this webinar is too… Hot Cold I think this training so far is… Good Bad

7. The Impact of BINARY THINKING Stigma and discrimination Collecting information about gender and sexual orientation

8. An Alternative for Intake Forms • What is your gender? Female Male Genderqueer • What was your sex at birth?   Female Male • Do you identify as transgender or transsexual? Yes No

9. Injustice at Every Turn A look at Latino/a respondents in the National Transgender Discrimination Survey

10. Injustice at Every TurnFor the full report and detailed recommendations, please visit www.TheTaskForce.org or www.TransEquality.org http://www.thetaskforce.org/reports_and_research/ntds or http://transequality.org/Resources/index.htmlMore information about the survey is available at www.EndTransDiscrimination.org.

11. Key Findings • Discrimination was pervasive for all respondents who took the National Transgender Discrimination Survey, yet the combination of anti-transgender bias and persistent structural and interpersonal acts of racism was especially devastating for Latino/a transgender people and other people of color.

12. Key Findings • Non-citizen Latino/a respondents were often among those most vulnerable to harassment, abuse and violence in the study.

13. Key Findings • Latino/a transgender and gender non-conforming people are affected by HIV in devastating numbers. One in twelve Latino/a respondents were HIV positive (8.44%)

15. Key Findings • Twenty-three percent (23%) of Latino/a respondents reported being refused medical care due to bias. • Thirty-six percent (36%) of Latino/a respondents reported postponing care when they were sick or injured due to fear of discrimination.

16. Case Study #1 A 21-year-old Latino male and his female partner come in for HIV/STI testing. He is seen first and is considered low-risk since he was tested one year ago and has only had sex with his partner. He report having unprotected anal and oral sex and shows no symptoms of an STI. He doesn’t like to use condoms and neither does his partner. “It feels hotter without a rubber,” he informs the counselor. His INSTI 1 Minute HIV test comes back negative and he is provided with education about using lubricant for anal sex and is also provided with lubricant and larger condoms as he informed the counselor that he often finds condoms constricting. He states that he will consider trying the condoms out but does not see a need. He will be returning in 10 days for his STI results.

17. Case Study #1 (continued) His partner, a 19 year old Latina is screened next and she informs the counselor that while she was assigned male at birth, she identifies as female. In Mexico, she began getting facial feminization surgery, had breast implants, and obtained female hormones but she still has a penis. She tells the counselor that she only has unprotected anal sex with her partner and that she is always the one penetrated because he is heterosexual identified and recognizes that she is a woman. But since she is undocumented and her ID’s do not match how what she looks now she cannot find work so she engages in commercial sex work 20-30 times a week. Her partner thinks that she works downtown near the border crossing at a shoe store and is unaware that she is having anal receptive, anal penetrative and oral sex with multiple partners. She does not use condoms for oral sex and receives and gives oral service to her customers.

18. Case Study #1 (continued) Her INSTI 1 Minute HIV test comes back negative but she reports that a week earlier a client’s condom broke during receptive anal sex so she will need to test again in three weeks. She is provided with education about using generous amounts of lubricant for receptive and penetrative anal sex and provided with lube and several dozen condoms. She informs the counselor that she has had a burning sensation during urination and will be returning in 10 days for her STI results. 1. What would be your number one goal or first priority in working with this couple? 2. What conversations, if any, would you have with the female identified client about how to protect her partner?

19. Case Study #2 Two Latino MSM visit your agency for HIV testing. The first one to test is 38 years old. He reports having unprotected penetrative and oral sex with multiple men including his partner of 10 years. He understands that as the penetrative person he is at lower risk for HIV and claims not to be worried about the other STI’s and he routinely tests for HIV and STI’s every 3 months. His INSTI 1 Minute HIV test comes back negative and he is provided with education about using generous amounts of lubricant for anal sex and is provided with lubricant packets but refuses condoms and is not receptive to a discussion on condoms. He will be returning in 10 days for his STI results.

20. Case Study #2 (continued) The second male to test is 29 years old. He reports sharing multiple men with his primary partner but states that he only has unprotected anal sex with his partner and he has unprotected oral sex with all the men they share. He states that he is less worried about himself and more worried about his partner’s health but isn’t sure how to approach the issue. He enjoys having multiple partners but states that he is very secretive about his activities because he knows that his friends and family would judge them. His INSTI 1 Minute HIV test comes back negative, he is provided with education about using generous amounts of lubricant for anal sex and is provided with lubricant packets as well as a variety of condoms.

21. Case Study #2 (continued) The counselor offers some examples of how to approach his partner about his concerns. But the younger man states that the couple never discuss sex. They just know that on weekends they will use Grindr (a geo social networking app) to meet new people. He will be returning in 10 days for his STI results. Ten days later they both discover that they have contracted syphilis. 1. What are some strategies you would utilize to help this couple address the issues that have put them at risk? 2. What are some options you could offer the couple to help them make safer choices moving forward?

22. Counseling Gender Diverse Clients Practice culturally proficient and client-centered counseling techniques: • Ask about and respect client’s self identification • Provide all staff with education and training around gender and sexual diversity • Modify paperwork and intake forms to reflect gender and sexual diversity

23. Counseling Diverse Clients Clients indicated that what motivated them to continue seeking services: (a) rapport with provider (b) effective therapeutic techniques and models, and (c) internal drive to get well. From Capacity Building Project: Serving the Mental Health and Substance AbuseNeeds of HIV Infected Persons in Texas

24. Counseling Diverse Clients Specifically when discussing the relationship with their providers, clients mentioned the importance of trust, being listened to, and having someone who“acts like they care.” This relationship factor was noted as more important than their providers' understanding of HIV or LGBT issues. From Capacity Building Project: Serving the Mental Health and Substance AbuseNeeds of HIV Infected Persons in Texas

25. Questions? Thank you for joining us for this webinar!